Name: 저자 스포트라이트: Tuina와 함께 무릎 골관절염 치료 - 새로운 관점
Uploaded: 2024-01-12T13:15:00
Description: Watch this Scientific Journal Video about Treating Knee Osteoarthritis with Tuina - A New Perspective at JoVE.com

이 연구는 중국 국립 자연 과학 재단 (NO.82105042, 82205302)의 지원을받습니다. 상하이 박사후 과정 우수 프로그램(NO.2020371); 중국 박사후 과학 재단(NO.2021M692156); 상하이 항해 프로그램(NO.20YF1450900); 중국 전통 및 서양 통합 병원 Yueyang 과학 재단 (NO.2021yygq03). 자금 제공자는 연구의 설계, 실행 또는 작성에 아무런 역할도 하지 않았습니다.

모든 실험은 상하이 중국 전통 의학 대학 동물 관리 및 사용 위원회(승인 번호: SYXK2018-0040)의 승인 및 감독을 받았으며, 이는 세계 의학 협회 헬싱키 선언의 규정을 준수합니다.
1. 동물 준비
<ol><li>House 32 Sprague Dawley (SD) 수컷 쥐는 표준 설치류 펠릿 식단으로 24 ± 2 ° C 및 60 % 습도에서 12 시간 빛 / 12 시간 어두움주기 아래 특정 병원체가없는 하우징 장치에서 8 주 ?...

무릎 골관절염에 대한 Tuina 마사지의 치료 잠재력

<ol>
	<li>Katz, J. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+and+treatment+of+hip+and+knee+osteoarthritis:+A+review.">Diagnosis and treatment of hip and knee osteoarthritis: A review.</a> JAMA. 325 (6), 568-578 (2021).</li><li>Culvenor, A. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+knee+osteoarthritis+features+on+magnetic+resonance+imaging+in+asymptomatic+uninjured+adults:+a+systematic+review+and+meta-analysis.">Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.</a> Br J Sports Med. 53 (20), 1268-1278 (2019).</li><li>Safiri, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=regional+and+national+burden+of+osteoarthritis+1990-2017:+a+systematic+analysis+of+the+Global+Burden+of+Disease+Study+2017.">regional and national burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017.</a> Ann Rheum Dis. 79 (6), 819-828 (2020).</li><li>Kong, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Traditional+Chinese+exercises+on+pain+and+disability+in+middle-aged+and+elderly+patients+with+neck+pain:+a+systematic+review+and+meta-analysis+of+randomized+controlled+trials.">Traditional Chinese exercises on pain and disability in middle-aged and elderly patients with neck pain: a systematic review and meta-analysis of randomized controlled trials.</a> Front Aging Neurosci. 14, 912-945 (2022).</li><li>Nevitt, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Symptoms+of+knee+instability+as+risk+factors+for+recurrent+falls.">Symptoms of knee instability as risk factors for recurrent falls.</a> Arthritis Care Res (Hoboken). 68 (8), 1089-1097 (2016).</li><li>Hunter, D. J., March, L., Chew, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Osteoarthritis+in+2020+and+beyond:+a+Lancet+Commission).">Osteoarthritis in 2020 and beyond: a Lancet Commission).</a> Lancet. 396 (10264), 1711-1712 (2020).</li><li>Fan, Z. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interpretation+and+evaluation+of+the+Chinese+Osteoarthritis+Treatment+Guidelines+(2021+Edition).">Interpretation and evaluation of the Chinese Osteoarthritis Treatment Guidelines (2021 Edition).</a> Chinese Journal of Evidence-Based Medicine. 22 (06), 621-627 (2022).</li><li>Chen, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Design+of+an+epidemiological+survey+on+the+prevalence+of+osteoarthritis+of+the+knee+in+a+middle-aged+and+elderly+population+in+China.">Design of an epidemiological survey on the prevalence of osteoarthritis of the knee in a middle-aged and elderly population in China.</a> Journal of Hebei Medical University. 36 (04), 487-490 (2015).</li><li>Shao, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Study+on+the+mechanism+of+regulating+the+&amp;#34;balance+of+tendon+and+bone+force&amp;#34;+in+the+treatment+of+knee+osteoarthritis+by+Tui+Na+manipulation.">Study on the mechanism of regulating the &amp;#34;balance of tendon and bone force&amp;#34; in the treatment of knee osteoarthritis by Tui Na manipulation.</a> Shanghai University of Traditional Chinese Medicine. , 107-108 (2020).</li><li>Liu, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+and+mechanism+of+PD-1/PD-L1+pathway+in+osteoarthritis+in+mice.">Role and mechanism of PD-1/PD-L1 pathway in osteoarthritis in mice.</a> Shandong University. , 130-134 (2020).</li><li>Shoujian, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=PD-1+promotes+the+repair+and+regeneration+of+contused+skeletal+muscle+by+regulating+Treg+cells+and+macrophages.">PD-1 promotes the repair and regeneration of contused skeletal muscle by regulating Treg cells and macrophages.</a> Shanghai Institute of Physical Education. , 54-58 (2020).</li><li>Levinger, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+level+of+FoxO1+and+IL-15+in+skeletal+muscle,+serum+and+synovial+fluid+in+people+with+knee+osteoarthritis:+a+case+control+study.">The level of FoxO1 and IL-15 in skeletal muscle, serum and synovial fluid in people with knee osteoarthritis: a case control study.</a> Osteoporos Int. 27 (6), 2137-2143 (2016).</li><li>Niu, Q., Xie, C., Jiang, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Advances+in+Chinese+medicine+based+on+PI3K/AKT+signaling+pathway+for+the+treatment+of+knee+osteoarthritis.">Advances in Chinese medicine based on PI3K/AKT signaling pathway for the treatment of knee osteoarthritis.</a> Massage and Rehabilitation Medicine. , 1-5 (2022).</li><li>Liu, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Blocking+of+checkpoint+receptor+PD-L1+aggravates+osteoarthritis+in+macrophage-dependent+manner+in+the+mice+model.">Blocking of checkpoint receptor PD-L1 aggravates osteoarthritis in macrophage-dependent manner in the mice model.</a> Int J Immunopathol Pharmacol. 33, 2058-2073 (2019).</li><li>Molanouri, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+effect+of+aerobic+interval+training+and+selenium+nanoparticles+on+expression+of+IL-15+and+IL-10/TNF-alpha+ratio+in+skeletal+muscle+of+4T1+breast+cancer+mice+with+cachexia.">Combined effect of aerobic interval training and selenium nanoparticles on expression of IL-15 and IL-10/TNF-alpha ratio in skeletal muscle of 4T1 breast cancer mice with cachexia.</a> Cytokine. 90, 100-108 (2017).</li><li>Mahmoudian, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early-stage+symptomatic+osteoarthritis+of+the+knee+-+time+for+action.">Early-stage symptomatic osteoarthritis of the knee - time for action.</a> Nat Rev Rheumatol. 17 (10), 621-632 (2021).</li><li>Nahin, R. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evidence-based+evaluation+of+complementary+health+approaches+for+pain+management+in+the+United+States.">Evidence-based evaluation of complementary health approaches for pain management in the United States.</a> Mayo Clin Proc. 91 (9), 1292-1306 (2016).</li><li>Bervoets, D. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Massage+therapy+has+short-term+benefits+for+people+with+common+musculoskeletal+disorders+compared+to+no+treatment:+a+systematic+review.">Massage therapy has short-term benefits for people with common musculoskeletal disorders compared to no treatment: a systematic review.</a> J Physiother. 61 (3), 106-116 (2015).</li><li>Xu, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+of+tui+na+in+treating+pain+after+total+knee+replacement+for+knee+osteoarthritis.">Effectiveness of tui na in treating pain after total knee replacement for knee osteoarthritis.</a> Chinese Tissue Engineering Research. 25 (18), 2840-2845 (2021).</li><li>Ali, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Massage+therapy+and+quality+of+life+in+osteoarthritis+of+the+knee:+a+qualitative+study.">Massage therapy and quality of life in osteoarthritis of the knee: a qualitative study.</a> Pain Med. 18 (6), 1168-1175 (2017).</li><li>Yoh, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+injection+of+monoiodoacetate+induces+diverse+hip+osteoarthritis+in+rats,+depending+on+its+dose.">Intra-articular injection of monoiodoacetate induces diverse hip osteoarthritis in rats, depending on its dose.</a> BMC Musculoskelet Disord. 23 (1), 494-487 (2022).</li><li>Lockwood, S. 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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Animal+models+of+osteoarthritis:+Comparisons+and+key+considerations.">Animal models of osteoarthritis: Comparisons and key considerations.</a> Vet Pathol. 52 (5), 803-818 (2015).</li><li>Guo, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exploring+the+effect+of+pushing+on+cartilage+in+rats+with+knee+osteoarthritis+based+on+ROCK/LIMK1/Cofilin+signaling+pathway.">Exploring the effect of pushing on cartilage in rats with knee osteoarthritis based on ROCK/LIMK1/Cofilin signaling pathway.</a> Chongqing Medical University. , 42-44 (2022).</li><li>Liu, Z. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tuina+for+peripherally-induced+neuropathic+pain:+A+review+of+analgesic+mechanism.">Tuina for peripherally-induced neuropathic pain: A review of analgesic mechanism.</a> Front Neurosci. 16, 1096-1104 (2022).</li><li>Gebremariam, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Subacromial+impingement+syndrome--effectiveness+of+physiotherapy+and+manual+therapy.">Subacromial impingement syndrome--effectiveness of physiotherapy and manual therapy.</a> Br J Sports Med. 48 (16), 1202-1208 (2014).</li><li>Yao, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcriptome+profiling+of+microRNAs+reveals+potential+mechanisms+of+manual+therapy+alleviating+neuropathic+pain+through+microRNA-547-3p-mediated+Map4k4/NF-kappab+signaling+pathway.">Transcriptome profiling of microRNAs reveals potential mechanisms of manual therapy alleviating neuropathic pain through microRNA-547-3p-mediated Map4k4/NF-kappab signaling pathway.</a> J Neuroinflammation. 19 (1), 211-221 (2022).</li><li>Valera-Calero, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endocrine+response+after+cervical+manipulation+and+mobilization+in+people+with+chronic+mechanical+neck+pain:+a+randomized+controlled+trial.">Endocrine response after cervical manipulation and mobilization in people with chronic mechanical neck pain: a randomized controlled trial.</a> Eur J Phys Rehabil Med. 55 (6), 792-805 (2019).</li><li>Kovanur, S. 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본 연구는 표준화된 행동지표를 이용하여 투이나의 중재 후 KOA의 개선을 평가하고, KOA에 대한 투이나의 기전과 골격근과 KOA의 연관성을 조사하는 것을 목적으로 한다. 약물 및 수술 요법과 달리 Tuina는 운동계, 면역계 및 내분비계에 긍정적인 조절 효과가 있습니다. Tuina는 다양한 표적에 작용하여 질병으로 인한 염증과 통증을 완화할 수 있습니다. 예를 들어, TLR4 경로와 miRNA를 조절함으로써 신경?...

무릎 골관절염(KOA)은 만성 통증과 장애를 특징으로 하는 흔한 퇴행성 골관절염으로, 비교적 심한 골관절염은 관절에 돌이킬 수 없는 구조적 손상을 초래한다1. KOA의 높은 세계적 유병률은 주요 글로벌 공중보건 과제가 되었으며2,3 이는 환자의 삶의 질을 심각하게 손상시킨다4,5. 연구에 따르면 KOA는 전 세계적으로 2억 6천만 명 이상의 사람들에게 영향을 미치는 것으로 나타났습니다6. 인구 고령화로 인해 중국의 KOA 총 유병률은 40세 이상 17.0%에 달해 7,8 감염자 가족들에게 큰 부담이 되고 있다.
한의학에 따르면, KOA는 "마비"의 범주에 속하며,9 황제의 내과 고전은 힘줄, 뼈 및 살을 마비와 연관시킵니다. 따라서 KOA에서 무릎 관절 주변의 연골, 근육, 활막 및 기타 조직 간의 연결에 주의를 기울여야 합니다. 현대의학에서는 관절염의 면역 항상성의 주요 구성 요소인 근육과 뼈의 염증이 관절염의 진행을 촉진합니다. 그러나 대부분의 연구는 골관절의 연골 염증과 활막 염증에 초점을 맞추고 있으며, 골격근의 염증 현상을 조사한 논문은 부족하다. 따라서 염증에서 골격근의 역할에 대한 더 많은 연구가 필요하며, KOA에 대한 보다 포괄적인 이해를 얻고 보다 효과적인 치료 방식에 대한 아이디어를 제공할 수 있습니다. 문헌 검토에서 면역 관련 인자 프로그램된 죽음 리간드 1(PD-L1)의 억제가 KOA 10,11의 진행을 악화시켰고, KOA 12 환자의 골격근에서IL-15와 FOXO1의 차등 발현이 있었으며, 말기 KOA 환자에서 상당한 골격근 염증이 있음을 확인했다. 이는 또한 걸음걸이의 변화와 관련이 있었습니다. 골격근은 IL-6와 같은 염증성 면역과 밀접한 관련이 있는 인자도 분비할 수 있으며, TNF-α도 PD-L1 경로 및 KOA13,14,15와 밀접한 관련이 있는 것으로 나타났습니다.
현재 KOA에 사용할 수 있는 치료법에는 체중 조절, 운동, 약물 및 수술이 포함되며, 일반적으로 관절 내 주사, 진통제, 관절경 수술, 무릎 보철 주위 절골술등이 포함된다 16. 현재 KOA 질환의 진행은 완전히 멈추거나 되돌릴 수 없으며, KOA 통증의 기저에 있는 복잡한 기전을 명확하게 이해하지 못하면 KOA 환자는 진통제 남용 및 높은 부작용 발생률의 위험에 처해 있다8. 대부분의 치료 전략은 단기간에만 효과적이며 질병의 발병기전보다는 증상의 일시적인 완화에만 초점을 맞춥니다. 따라서 KOA 통증은 치료의 우선 순위이자 과제로 남아 있어 심각한 임상적 도전을 제기합니다. 그러나 Tuina는 KOA 치료에서 영향을 받은 관절 주변의 골격근을 직접 자극할 수 있으며 몇 가지 이점을 제공할 수 있습니다. 이전 설명과 결합하여 KOA에서 골격근 조직의 역할을 연구하는 이상적인 치료법이며 염증에서 골격근 조직의 역할을 명확히 하는 것도 KOA의 Tuina에 대한 더 나은 이론적 지원을 제공할 수 있습니다.
연구에 따르면 마사지 요법, 정골 수기 요법 및 척추 조작은 통증을 완화하고 신체 기능을 회복하는 데 도움이 될 수 있습니다17,18. 이러한 조작은 국소 염증에 작용하고 외부 기계적 작용을 통해 경련과 진통을 완화할 수 있습니다. 무릎 인공관절 전치환술 후 통증을 완화하고, 진통제 사용을 줄이고, 수술 후 회복을 촉진하고, 생체역학적 균형을 개선할 수 있다19. 스웨덴 마사지는 골관절염 치료에 가능하며 스트레스를 줄이고 삶의 질을 향상시킬 수 있습니다20. KOA에 대한 Tuina의 치료 효과는 특정 연구에 선행되었습니다.
본 연구팀은 쥐의 MIA 유도 KOA 모델을 기반으로 골격근에서 PD-L1 및 관련 염증 인자의 발현이 KOA를 유도하고 발달을 촉진할 수 있는지 여부를 탐구할 것입니다. 염증인자 발현 증가로 인한 KOA 증상을 완화할 수 있는지 확인하기 위해 투이나도 시행할 예정이다. Tuina는 KOA 발달과 통증에 영향을 미치는 골격근 염증에서 Tuina 매개 PD-1 경로 사이의 연관성을 입증하기 위해 PD-L1 억제와 결합되어 KOA에 대한 Tuina 개입의 치료 메커니즘에 대한 추가 다단계 연구의 토대를 마련할 것입니다.
요약하면, 본 논문은 KOA의 발병에 따른 골격근 염증의 메커니즘과 통증, KOA에 대한 Tuina의 치료 효과에 대한 조사 및 정교화를 면역 염증 인자 발현의 관점에서 설명하고, 행동 관련 지표와 결합하여 한의학의 "힘줄과 뼈의 불균형" 이론에 대한 현대 연구 증거를 제공합니다.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Anti-PD-L1</td>
			<td>Abcam, Cambridge, MA, USA</td>
			<td>ab80276</td>
			<td></td>
		</tr>
		<tr>
			<td>electric von Frey esthesiometer&#160;</td>
			<td>IITC/Life Science, Woodland Hills, CA, USA</td>
			<td>ALMEMO 2450</td>
			<td></td>
		</tr>
		<tr>
			<td>GraphPad Prism 9.0</td>
			<td>GraphPad Software</td>
			<td></td>
			<td>Software for stastistical analysis</td>
		</tr>
		<tr>
			<td>monosodium iodoacetate</td>
			<td>Sigma-Aldrich Inc</td>
			<td>I9148</td>
			<td>Resolved into normal saline for injection</td>
		</tr>
		<tr>
			<td>pentasorbital sodium</td>
			<td>Sigma-Aldrich Inc</td>
			<td>P3761</td>
			<td></td>
		</tr>
		<tr>
			<td>Sprague Dawley (SD) male rats</td>
			<td>Shanghai Jihui Experimental Animal Breeding Co., Ltd</td>
			<td>No. SCXK (Hu) 2017-0012</td>
			<td></td>
		</tr>
		<tr>
			<td>thermal analgesia tester</td>
			<td>IITC/Life Science</td>
			<td>Model 390</td>
			<td></td>
		</tr>
	</tbody>
</table>

tuina intervention in sodium monoiodoacetate injection-induced rat model of knee osteoarthritis

흔한 퇴행성 관절 질환인 무릎 골관절염(KOA)은 만성 통증과 장애를 특징으로 하며, 이는 관절의 돌이킬 수 없는 구조적 손상으로 진행될 수 있습니다. 관절 연골, 근육, 활막 및 무릎 관절을 둘러싼 기타 조직 간의 연관성에 대한 조사는 매우 중요합니다. 현재 KOA 관리에는 생활 습관 수정, 운동, 약물 및 외과적 개입이 포함됩니다. 그러나 KOA 관련 통증의 기저에 있는 복잡한 메커니즘에 대한 해명은 아직 부족합니다. 결과적으로, KOA 통증은 여전히 중요한 임상적 과제이자 치료의 우선 순위로 남아 있습니다. 투이나는 운동계, 면역계, 내분비계에 조절 효과가 있는 것으로 밝혀져 염증 인자의 상향 조절로 인한 KOA 증상을 완화할 수 있는지, 더 나아가 골격근의 염증 인자가 KOA의 진행을 촉진할 수 있는지에 대한 탐구를 촉발했습니다.
32마리의 수컷 Sprague Dawley(SD) 쥐(180-220g)를 각각 8마리씩 4개 그룹, 즉 antiPD-L1+Tuina(그룹 A), 모델(그룹 B), Tuina(그룹 C) 및 가짜 수술(그룹 D)로 무작위 배정했습니다. 그룹 A, B, C의 경우 25μL의 모노요오드아세트산나트륨(MIA) 용액(25μL의 멸균 식염수로 희석한 MIA 4mg)을 오른쪽 무릎 관절강에 주입하고, 그룹 D의 경우 동일한 양의 멸균 생리식염수를 주입했습니다. 모든 그룹은 주사 전과 주사 후 2일, 9일, 16일 동안 스트레스가 가장 적은 테스트(발 기계적 금단 역치, 발 철수 열 잠복기, 오른쪽 무릎 관절 부종, Lequesne MG 점수, 피부 온도)를 사용하여 평가되었습니다.

Knee osteoarthritis (KOA) is a common degenerative osteoarthritis, characterized by chronic pain and disability, and relatively severe KOA will lead to irreversible structural damage to the joint1. The high global prevalence of KOA has become a major global public health challenge2,3, which seriously impairs the quality of life of patients4,5. Studies have shown that KOA affects more than 260 million people worldwide6. With the aging of the population, the total prevalence rate of KOA in China is as high as 17.0% over the age of 40, which puts a heavy burden on the families of those affected7,8.
According to Chinese medicine, KOA belongs to the category of &#34;paralysis&#34;9, and the Yellow Emperor&#39;s Classic of Internal Medicine associates tendons, bones, and flesh with paralysis. Hence, we need to pay attention to the connection between the cartilage, muscle, synovium, as well as other tissues around the knee joint in KOA. In modern medicine, both muscle and bone inflammation, which are major components of the immune homeostasis of arthritis, drive the progression of KOA pain. However, most studies focus on cartilage inflammation and synovial inflammation in bone joints, and there is a paucity of articles examining inflammatory phenomena in skeletal muscles. Therefore, more research on the role of skeletal muscle in inflammation is needed to gain a more comprehensive understanding of KOA and provide ideas for more effective treatment modalities. In a review of the literature, we found that inhibition of the immune-related factor programmed death ligand 1 (PD-L1) exacerbated the progression of KOA10,11 and that there was differential expression of IL-15 and FOXO1 in the skeletal muscle of patients with KOA12, as well as significant skeletal muscle inflammation in patients with end-stage KOA, which was also associated with changes in gait. It has been shown that the skeletal muscle can also secrete factors closely related to inflammatory immunity such as IL-6, and that TNF-&#945; is also closely related to the PD-L1 pathway and KOA13,14,15.
Currently, available treatments for KOA include weight control, exercise, medication, and surgery, which usually include intra-articular injections, analgesic medication, arthroscopic surgery, and periprosthetic osteotomy of the knee16. Currently, KOA disease progression cannot be completely stopped or reversed, and without a clear understanding of the complex mechanisms underlying KOA pain, KOA patients are at risk for overuse of analgesic medications and a high incidence of side effects8. Most treatment strategies are effective only for short periods and focus only on the temporary relief of symptoms rather than on the pathogenesis of the disease. Therefore, KOA pain remains a priority and a challenge for treatment, posing a serious clinical challenge. However, Tuina can directly stimulate the skeletal muscles around the affected joint in KOA treatment and can provide some benefits. Combined with the previous description, it is the ideal therapy to study the role of skeletal muscle tissue in KOA, and clarifying the role of skeletal muscle tissue in inflammation can also provide better theoretical support for Tuina of KOA.
Studies have shown that massage therapy, osteopathic manipulative therapy, and spinal manipulation can help relieve pain and restore body function17,18. These manipulations can act on local inflammation and relieve spasms and analgesia through external mechanical action. They can relieve pain after total knee arthroplasty, reduce the use of analgesic drugs, promote postoperative recovery, and improve biomechanical balance19. Swedish massage is feasible in the treatment of osteoarthritis and can reduce stress and improve quality of life20. The therapeutic effect of Tuina on KOA has been preceded by certain studies.
In this experiment, our team will explore whether the expression of PD-L1 and related inflammatory factors in skeletal muscle can induce KOA and promote its development based on the MIA-induced KOA model in rats. Tuina will also be implemented to see whether it can alleviate KOA symptoms caused by increased inflammatory factor expression. Tuina will be combined with PD-L1 inhibition to demonstrate the association between Tuina-mediated PD-1 pathway in skeletal muscle inflammation affecting KOA development and pain, laying the foundation for further multi-level studies on the therapeutic mechanisms of Tuina intervention in KOA.
In summary, this paper describes the investigation and elaboration of the mechanisms of skeletal muscle inflammation in the development of KOA and its pain, as well as the therapeutic effects of Tuina on KOA, from the perspective of immune-inflammatory factor expression, combined with behavioral related indicators, to provide modern research evidence for the &#34;imbalance of tendon and bone&#34; theory in traditional Chinese medicine.

저자 스포트라이트: Tuina와 함께 무릎 골관절염 치료 - 새로운 관점 

무릎 골관절염의 나트륨 모노요오드아세트산 주사 유도 쥐 모델에 대한 Tuina 개입

We are trying to broaden the views on the research of knee osteoarthritis by introducing the perspective of refocusing on muscle inflammation during the pathological process of the KOA. There is a recent trend in non-pharmacological therapy treating the knee osteoarthritis. Therapy measures of traditional Chinese medicine, such as TNA and acupuncture, are receiving more and more recognition.There is a calling for detailed mechanism in the treatment. Our experiments indicates the possibility of chronic muscle inflammation in the process of knee osteoarthritis. It also points out the possibility of non-pharmacological therapy such as TNA to treat and control it.

설명된 프로토콜은 Yueyang Hospital of Integrated Traditional Chinese and Western Medicine의 임상 환경에서 구현되었습니다. 그림 1은 쥐에서 밀어 넣은 경혈의 정확한 위치를 보여주며, 표 1 은 이러한 점을 자극하는 일반적인 이점을 보여줍니다. 표 2 및 표 3 은 PD-1 경로 억제가 없는 경우에도 Tuina 요법을 통해 달성된 주목할 만한 통증 완화에 대한 강?...

Watch this Scientific Journal Video about Treating Knee Osteoarthritis with Tuina - A New Perspective at JoVE.com

이 프로토콜은 무릎 골관절염(KOA)의 모노요오드아세트산 나트륨 주사 유도 쥐 모델에 대한 Tuina 개입 방법을 설명하며, 이는 KOA 동물 모델에서 Tuina의 적용에 대한 참조를 제공합니다. 이 프로토콜은 또한 KOA에 대한 Tuina의 효과적인 메커니즘을 연구하며, 그 결과는 그 적용을 촉진하는 데 도움이 될 것입니다.

Knee osteoarthritis (KOA), a common degenerative joint disorder, is characterized by chronic pain and disability, which can progress to irreparable ...

무릎 골관절염 연구의 시야를 넓히기 위해 KOA의 병리학적 과정에서 근육 염증에 대한 관점을 다시 집중하는 관점을 소개하고자 합니다. 최근 무릎 골관절염을 치료하는 비약물적 치료가 유행하고 있습니다. TNA와 침술과 같은 중국 전통 의학의 치료 수단은 점점 더 많은 인정을 받고 있습니다.치료에 대한 자세한 메커니즘에 대한 요구가 있습니다. 우리의 실험은 무릎 골관절염 과정에서 만성 근육 염증의 가능성을 시사한다. 또한 TNA와 같은 비약물적 요법을 통해 치료하고 조절할 수 있는 가능성도 제시하고 있다.

tuina-intervention-sodium-monoiodoacetate-injection-induced-rat-model

Research

JoVE Journal

Medicine

Tuina Intervention in Sodium Monoiodoacetate Injection-Induced Rat Model of Knee Osteoarthritis

Knee osteoarthritis (KOA), a common degenerative joint disorder, is characterized by chronic pain and disability, which can progress to irreparable structural damage of the joint. Investigations into the link between articular cartilage, muscles, synovium, and other tissues surrounding the knee joint in KOA are of great importance. Currently, managing KOA includes lifestyle modifications, exercise, medication, and surgical interventions; however, the elucidation of the intricate mechanisms underlying KOA-related pain is still lacking. Consequently, KOA pain remains a key clinical challenge and a therapeutic priority. Tuina has been found to have a regulatory effect on the motor, immune, and endocrine systems, prompting the exploration of whether Tuina could alleviate KOA symptoms, caused by the upregulation of inflammatory factors, and further, if the inflammatory factors in skeletal muscle can augment the progression of KOA.
We randomized 32 male Sprague Dawley (SD) rats (180-220 g) into four groups of eight animals each: antiPD-L1+Tuina (group A), model (group B), Tuina (group C), and sham surgery (group D). For groups A, B, and C, we injected 25 &#181;L of sodium monoiodoacetate (MIA) solution (4 mg MIA diluted in 25 &#181;L of sterile saline solution) into the right knee joint cavity, and for group D, the same amount of sterile physiological saline was injected. All the groups were evaluated using the least to most stressful tests (paw mechanical withdrawal threshold, paw withdrawal thermal latency, swelling of the right knee joint, Lequesne MG score, skin temperature) before injection and 2, 9, and 16 days after injection.

This protocol describes the methods of Tuina intervention in sodium monoiodoacetate injection-induced rat model of knee osteoarthritis (KOA), which provides a reference for the application of Tuina in KOA animal models. This protocol also studies the effective mechanism of Tuina for KOA, and the results will help promote its application.